BACKGROUND: Delayed splenic rupture is the Achilles' heel of nonoperative management (NOM) for blunt splenic injury (BSI). Early computed tomographic (CT) scanning for features suggesting high risk of nonoperative failure, splenic pseudoaneurysms (SPAs), and arterial extravasation (AE), in concert with the appropriate use of splenic arterial embolization (SAE) is a viable method to reduce rates of failure of NOM. We report our 12-ear experience with a protocol for mandatory repeat CT evaluation at 48 hours and selective SAE. METHODS: A retrospective cohort analysis was performed on all consecutive adult trauma patients with BSI between 1995 and 2012. We evaluated an early/control (1995-1999) and a present/intervention (2000-2012) cohort in which SAE became available and 48-hour CT scans were implemented. RESULTS: The study included 773 patients (157 early vs. 616 present) with BSI. The proportion of patients managed nonoperatively (53% vs. 77%, p < 0.01) and overall splenic salvage rate (46% vs. 77%, p < 0.01) were improved in the present cohort. Among patients selected for NOM, there was a significant improvement in the failure rate of NOM (12% vs. 0.6%, p < 0.01) as well as in the length of hospital stay (8 days vs. 6 days, p < 0.01). Delayed development of SPA and/or AE was detected in 6% of BSI in the present cohort and was distributed among all grades of injury. CONCLUSION: The delayed development of SPA and AE is not an entirely rare event following BSI. Reevaluation with CT at 48 hours following admission and the use of SAE significantly decrease the failure rate of NOM. LEVEL OF EVIDENCE: Therapeutic study, level III.
BACKGROUND: Delayed splenic rupture is the Achilles' heel of nonoperative management (NOM) for blunt splenic injury (BSI). Early computed tomographic (CT) scanning for features suggesting high risk of nonoperative failure, splenic pseudoaneurysms (SPAs), and arterial extravasation (AE), in concert with the appropriate use of splenic arterial embolization (SAE) is a viable method to reduce rates of failure of NOM. We report our 12-ear experience with a protocol for mandatory repeat CT evaluation at 48 hours and selective SAE. METHODS: A retrospective cohort analysis was performed on all consecutive adult traumapatients with BSI between 1995 and 2012. We evaluated an early/control (1995-1999) and a present/intervention (2000-2012) cohort in which SAE became available and 48-hour CT scans were implemented. RESULTS: The study included 773 patients (157 early vs. 616 present) with BSI. The proportion of patients managed nonoperatively (53% vs. 77%, p < 0.01) and overall splenic salvage rate (46% vs. 77%, p < 0.01) were improved in the present cohort. Among patients selected for NOM, there was a significant improvement in the failure rate of NOM (12% vs. 0.6%, p < 0.01) as well as in the length of hospital stay (8 days vs. 6 days, p < 0.01). Delayed development of SPA and/or AE was detected in 6% of BSI in the present cohort and was distributed among all grades of injury. CONCLUSION: The delayed development of SPA and AE is not an entirely rare event following BSI. Reevaluation with CT at 48 hours following admission and the use of SAE significantly decrease the failure rate of NOM. LEVEL OF EVIDENCE: Therapeutic study, level III.
Authors: Harriet J Paltiel; Richard A Barth; Costanza Bruno; Aaron E Chen; Annamaria Deganello; Zoltan Harkanyi; M Katherine Henry; Damjana Ključevšek; Susan J Back Journal: Pediatr Radiol Date: 2021-05-12
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165